2013 Volume 19 Issue 4 Pages 347-354
Background: We sometimes experience the negative acetylcholine (ACh) findings in young rest angina patients irrespective of a strong suspicious VSA patient. We compared the positive frequency of provoked spasm by ACh test in rest angina patients between <40 years old and ≥40 years old. Methods and Results: We performed ACh spasm provocation tests during 22 years (1991–2012) in 1440 patients including 380 rest angina patients. We classified these 380 patients into two groups consisting of 12 younger patients (<40) and 368 older patients (≥40). We compared the coronary risk factors and spasm positive rate between the two groups. There was no difference concerning the coronary risk factors and organic stenosis between the two groups, while spasm positive rate by ACh was significantly lower in younger group than the older group (33.3% vs 71.5%, p<0.05). In advanced age, hypertension and diabetes mellitus increased. The cumulative coronary risk factors in younger group were significantly lower than those in older group. Positive spasm was obtained in one patient by ergonovine (ER) test and in 3 patients by adding ACh after ER test. Provoked spasm positive rate in younger group became similar to that in older group by performing sequential spasm provocation tests (66.7% vs 71.5%, ns). Conclusions: We recommend performing sequential spasm provocation tests in young rest angina patients.
